射频消融治疗转移性肝癌的临床疗效

目的探讨RFA治疗转移性肝癌的临床疗效。方法回顾性分析2004年1月至2008年12月第三军医大学西南医院收治的87例行RFA治疗的消化系统肿瘤肝转移患者的临床资料。其中结肠癌肝转移34例，直肠癌肝转移33例，胰腺癌肝转移12例，胃癌肝转移8例。采用生命质量评分和KPS评分分析患者情况。采用电话和门诊随访。术后6个月每月行超声造影或CT检查、复查肝功能和肿瘤标志物等。6个月后每2个月复查1次。随访时间截至2013年11月。计数资料采用矿检验或秩和检验。采用Kaplan—Meier法绘制生存曲线，生存率比较采用Log—rank检验。结果87例患者中84例成功施行RFA治疗，3例因患者无法耐受疼痛放弃RFA治疗，其中结肠癌2例、胃癌1例。84例患者中，共存在129个转移癌；经过RFA治疗后，107个转移癌经1次RFA后超声造影显示完全无强化，转移瘤1次完全毁损率达82．95％（107／129）；另22个转移癌因第1次RFA后有残留，均接受2次RFA治疗后被完全毁损。患者住院时间为（10．7±2．3）d（4～29d）。治疗前生命质量评分：60．7％（51／84）良好，22．6％（19／84）较好，10．7％（9／84）一般，6．0％（5／84）差；KPS评分：63．1％（53／84）改善，29．8％（25／84）稳定，7．1％（6／84）下降。治疗6个月生命质量评分（排除15例死亡患者）：78．2％（54／69）良好，11．6％（8／69）较好，5．8％（4／69）一般，4．4％（3／69）差。KPS评分：73．9％（51／69）的患者改善，21．7％（15／69）稳定，4．4％（3／69）下降。治疗前后患者生命质量及KPS评分差异均有统计学意义（，=29．760，17．140，P〈0．05）。全部患者均获随访，随访时间6～60个月。结肠癌肝转移患者进行RFA治疗后1、3、5年的生存率分别为68．8％、21．9％、6．3％，中位生存时间为21．5个月；直肠癌肝转移患者进行RFA治疗后1、3、5年的生存率分别为66．7％、27．3％、12．1％，中位生存时间为19．5个月；胰腺癌肝转移患者进行RFA治疗后1、3、5年的生存率分别为41．7％、0和0，中位生存时间为8．5个月；胃癌肝转移患者进行RFA治疗后1、3、5年的生存率分别为71．4％、14．3％和0，中位生存时间为16．5个月。胰腺癌肝转移与胃癌肝转移患者接受RFA治疗后生存率显著低于结直肠癌患者（X2=9．169，P〈0．05）。结论对无法手术切除或者肝转移癌较小的患者，RFA是较为有效的治疗方案，可延长患者生存时间，改善生命质量。

Clinical efficacy of radiofrequency ablation for the treatment of metastatic hepatic carcinoma

Objective To investigate the clinical efficacy of radiofrequency ablation for the treatment of metastatic hepatic carcinoma. Methods The clinical data of 87 patients with metastasis hepatic carcinoma who received radiofrequency ablation （ RFA ） at the Southwest Hospital from January 2004 to December 2008 were retrospectively analyzed. Of the 87 patients, 34 were with liver metastasis from colonic cancer, 33 with liver metastasis from rectal cancer, 12 with liver metastasis from pancreatic cancer, and 8 with liver metastasis from gastric cancer. The survival of the patients was analyzed by life score and kamofsky performance status （KPS） scale. Patients were followed up via phone call and out-patient examination. Ultrasonography, computed tomo- graphy, liver function and tumor markers test were done every month within postoperative 6 months, and every 2 months at 6 months later. The follow-up was ended in Novermber 2013. All data were analyzed using chi-square test or rank sum test. The survival curve was drawn by Kaplan-Meier method, and the survival rate was compared using the Log-rank test. Results Of the 87 patients, 84 were successfully treated by RFA, and 3 patients gave up RFA because of unbearable pain （2 patients with colonic cancer and 1 with gastric cancer）. A total of 129metastatic lesions were detected in the 84 patients, and 107 metastatic lesions were ablated after single RFA, with the success rate of 82.95% （107/129）. The other 22 lesions were ablated after a second RFA. The mean duration of hospital stay was （ 10.7 ± 2.3 ） days （ range, 4-29 days）. Before operation, the life quality was excellent in 60.7% （51/$4） of patients, good in 22.6% （19/84） of patients, fair in 10.7% （9/84） of patients, and poor in 6.0% （5/84） of patients. The candition of 63.1% （53/84） of patients was improved, 29.8% （25/84） of patients was stable, and 7.1% （6/84） of patients was deteriorated. At postoperative month 6, the life quality was excel- lent in 78.2% （54/69） of patients, good in 11.6% （8/69） of patients, fair in 5.8% （4/69） of patients, and poor in 4.4% （3/69） of patients. The condition of 73.9% （51/69） of patients was improved, 21.7% （15/69） of patients was stable, and 4.4% （3/69） of patients was deteriorated. There were significant differences in the life score and KPS scale between patients before and after operation （X2 = 29. 760, 17. 140, P 〈 0.05 ）. All patients were followed Up for 6-60 months. The 1-, 3-, 5-year survival rates of patients with liver metastasis from colonic cancer after RFA treatment were 68.8% , 21.9% and 6.3% , and the median survival time was 21.5 months. The 1, 3, 5-year survival rates of patients with liver metastasis from rectal cancer after RFA were 66.7%, 27.3%, 12.1%, and the median survival time was 19.5 months. The 1-, 3-, 5-year survival rates of patients with liver metastasis from pancreatic cancer after RFA treatment were 41.7% , 0 and 0, and the median survival time was 8.5 months. The 1-, 3-,5-year survival rates of patients with liver metastasis from gastric cancer after RFA treat- ment were 71.4%, 14.3% and O, and the median survival time was 16.5 months. The survival rates of patients with liver metastasis from pancreatic cancer and gastric cancer were significantly lower than those with liver metas- tasis from eoloreetal cancer after RFA （X2 = 9. 169, P 〈 0.05）. Conclusion The efficacy of RFA for seleeted patients with liver metastasis from digestive tract tumors is satisfaetory.